original article
Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review Edward Chamata BA1, Raman Mahabir MD1,2, Daniel Jupiter PhD1,2, Robert A Weber MD1,2
E Chamata, R Mahabir, D Jupiter, RA Weber. Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review. Plast Surg 2014;22(4):246-248. Background: Studies investigating the prevalence of brachial plexus injuries associated with scapular fractures are sparse, and are frequently limited by small sample sizes and often restricted to single-centre experience. OBJECTIVE: To determine the prevalence of brachial plexus injuries associated with scapular fractures; to determine how the prevalence varies with the region of the scapula injured; and to assess which specific nerves of the brachial plexus were involved. Methods: The present study was a retrospective review of data from the National Trauma Data Bank over a five-year period (2007 to 2011). Results: Of 68,118 patients with scapular fractures, brachial plexus injury was present in 1173 (1.72%). In patients with multiple scapular fractures, the prevalence of brachial plexus injury was 3.12%, and ranged from 1.52% to 2.22% in patients with single scapular fractures depending on the specific anatomical location of the fracture. Of the 426 injuries with detailed information on nerve injury, 208 (49%) involved the radial nerve, 113 (26.5%) the ulnar nerve, 65 (15%) the median nerve, 36 (8.5%) the axillary nerve and four (1%) the musculocutaneous nerve. Conclusion: The prevalence of brachial plexus injuries in patients with scapular fractures was 1.72%. The prevalence was similar across anatomical regions for single scapular fracture and was higher with multiple fractures. The largest percentage of nerve injuries were to the radial nerve. Key Words: Brachial plexus; National trauma data bank; Scapula; Scapular fracture
S
capular fractures comprise 3% to 5% of all shoulder girdle fractures, while accounting for 5 million cases from >900 registered US trauma centres, was used to gather the data (5).
La prévalence de lésions du plexus brachial chez les patients ayant des fractures scapulaires : l’analyse d’une banque nationale de données sur les traumatismes HISTORIQUE : Il existe peu d’études sur la prévalence de lésions du plexus brachial liées aux fractures scapulaires. Celles qui existent sont souvent limitées par le petit échantillon et sont restreintes à l’expérience d’un seul centre. OBJECTIF : Déterminer la prévalence de lésions du plexus brachial associées à des fractures scapulaires, établir la variation de la prévalence selon la région de l’omoplate qui est touchée et évaluer les nerfs du plexus brachial qui sont atteints. MÉTHODOLOGIE : La présente analyse rétrospective évaluait les données de la National Trauma Data Bank sur une période de cinq ans (2007 à 2011). RÉSULTATS : Chez les 68 118 patients ayant des fractures scapulaires, 1 173 (1,72 %) avaient une lésion du plexus brachial. Chez les patients ayant des fractures scapulaires multiples, la prévalence de lésions du plexus brachial s’élevait à 3,12 %, et elle variait entre 1,52 % et 2,22 % chez ceux qui en avaient une seule, selon la région anatomique où elle était située. De l’information détaillée était fournie sur la lésion nerveuse de 426 blessures : 208 (49 %) touchaient le nerf radial, 113 (26,5 %), le nerf cubital, 65 (15 %), le nerf médian, 36 (8,5 %), le nerf axillaire, et quatre (1 %), le nerf musculocutané. CONCLUSION : La prévalence de lésions du plexus brachial s’élevait à 1,72 % chez les patients ayant des fractures scapulaires. Cette prévalence était similaire entre les régions anatomiques lorsqu’il s’agissait d’une fracture scapulaire simple, et plus élevée lorsque les fractures étaient multiples. Les lésions nerveuses touchaient surtout le nerf radial.
Methods
The present study was a retrospective review of the NTDB data set from 2007 through 2011. The NTDB is an incident-centred database that uses International Classification of Diseases, Ninth Revision (ICD-9) codes to code for specific diagnoses. Because no patient identifiers exist in the database, patient incidents are represented with unique incident identifier keys. All incidents involving scapular fracture, as assessed according to ICD-9 diagnosis code, were extracted from the database. Specifically, scapular fractures were divided into six anatomical regions according to ICD-9 code: acromial process, coracoid process, body or spine grouped together, glenoid cavity or neck grouped together, multiple region fractures and unspecified region fractures. The scapular fracture data were accompanied by a list of other injuries associated with the given incident. Among these, injuries to the brachial plexus were of interest. Brachial plexus injuries were divided according to ICD-9 codes into injuries to specific nerves: axillary nerve, median nerve, musculocutaneous nerve, radial nerve, ulnar nerve, cutaneous sensory nerve of the upper limb, cervical root injury, other specified nerve injury, multiple nerve injury and unspecified nerve injury.
1Texas
A&M Health Sciences Center College of Medicine; 2Division of Plastic Surgery, Department of Surgery, Baylor Scott and White Health, Temple, Texas USA Correspondence: Mr Edward Chamata, Texas A&M Health Sciences Center College of Medicine, 2401 South 31st Street, Temple, Texas 76508, USA. Telephone 832-818-3541, e-mail [email protected]
246
©2014 Canadian Society of Plastic Surgeons. All rights reserved
Plast Surg Vol 22 No 4 Winter 2014
Brachial plexus injuries with scapular fractures
Table 1 Prevalence of brachial plexus injuries in scapular fractures Scapular fracture location
ICD-9 code (open Scapular Brachial plexus and closed fracture) fractures, n injuries*, n (%)
Unspecified location
811.00 and 811.10
39,314
Acromial process
811.01 and 811.11
2908
62 (2.13)
Coracoid process
811.02 and 811.12
2166
48 (2.22)
6361
122 (1.92)
14,769
263 (1.78)
Glenoid cavity or neck 811.03 and 811.13 Body or spine Multiple fracture
811.04 and 811.14 811.99
Total
597 (1.52)
2600
81 (3.12)
68,118
1173 (1.72)
*(P
Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review Edward Chamata BA1, Raman Mahabir MD1,2, Daniel Jupiter PhD1,2, Robert A Weber MD1,2
E Chamata, R Mahabir, D Jupiter, RA Weber. Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review. Plast Surg 2014;22(4):246-248. Background: Studies investigating the prevalence of brachial plexus injuries associated with scapular fractures are sparse, and are frequently limited by small sample sizes and often restricted to single-centre experience. OBJECTIVE: To determine the prevalence of brachial plexus injuries associated with scapular fractures; to determine how the prevalence varies with the region of the scapula injured; and to assess which specific nerves of the brachial plexus were involved. Methods: The present study was a retrospective review of data from the National Trauma Data Bank over a five-year period (2007 to 2011). Results: Of 68,118 patients with scapular fractures, brachial plexus injury was present in 1173 (1.72%). In patients with multiple scapular fractures, the prevalence of brachial plexus injury was 3.12%, and ranged from 1.52% to 2.22% in patients with single scapular fractures depending on the specific anatomical location of the fracture. Of the 426 injuries with detailed information on nerve injury, 208 (49%) involved the radial nerve, 113 (26.5%) the ulnar nerve, 65 (15%) the median nerve, 36 (8.5%) the axillary nerve and four (1%) the musculocutaneous nerve. Conclusion: The prevalence of brachial plexus injuries in patients with scapular fractures was 1.72%. The prevalence was similar across anatomical regions for single scapular fracture and was higher with multiple fractures. The largest percentage of nerve injuries were to the radial nerve. Key Words: Brachial plexus; National trauma data bank; Scapula; Scapular fracture
S
capular fractures comprise 3% to 5% of all shoulder girdle fractures, while accounting for 5 million cases from >900 registered US trauma centres, was used to gather the data (5).
La prévalence de lésions du plexus brachial chez les patients ayant des fractures scapulaires : l’analyse d’une banque nationale de données sur les traumatismes HISTORIQUE : Il existe peu d’études sur la prévalence de lésions du plexus brachial liées aux fractures scapulaires. Celles qui existent sont souvent limitées par le petit échantillon et sont restreintes à l’expérience d’un seul centre. OBJECTIF : Déterminer la prévalence de lésions du plexus brachial associées à des fractures scapulaires, établir la variation de la prévalence selon la région de l’omoplate qui est touchée et évaluer les nerfs du plexus brachial qui sont atteints. MÉTHODOLOGIE : La présente analyse rétrospective évaluait les données de la National Trauma Data Bank sur une période de cinq ans (2007 à 2011). RÉSULTATS : Chez les 68 118 patients ayant des fractures scapulaires, 1 173 (1,72 %) avaient une lésion du plexus brachial. Chez les patients ayant des fractures scapulaires multiples, la prévalence de lésions du plexus brachial s’élevait à 3,12 %, et elle variait entre 1,52 % et 2,22 % chez ceux qui en avaient une seule, selon la région anatomique où elle était située. De l’information détaillée était fournie sur la lésion nerveuse de 426 blessures : 208 (49 %) touchaient le nerf radial, 113 (26,5 %), le nerf cubital, 65 (15 %), le nerf médian, 36 (8,5 %), le nerf axillaire, et quatre (1 %), le nerf musculocutané. CONCLUSION : La prévalence de lésions du plexus brachial s’élevait à 1,72 % chez les patients ayant des fractures scapulaires. Cette prévalence était similaire entre les régions anatomiques lorsqu’il s’agissait d’une fracture scapulaire simple, et plus élevée lorsque les fractures étaient multiples. Les lésions nerveuses touchaient surtout le nerf radial.
Methods
The present study was a retrospective review of the NTDB data set from 2007 through 2011. The NTDB is an incident-centred database that uses International Classification of Diseases, Ninth Revision (ICD-9) codes to code for specific diagnoses. Because no patient identifiers exist in the database, patient incidents are represented with unique incident identifier keys. All incidents involving scapular fracture, as assessed according to ICD-9 diagnosis code, were extracted from the database. Specifically, scapular fractures were divided into six anatomical regions according to ICD-9 code: acromial process, coracoid process, body or spine grouped together, glenoid cavity or neck grouped together, multiple region fractures and unspecified region fractures. The scapular fracture data were accompanied by a list of other injuries associated with the given incident. Among these, injuries to the brachial plexus were of interest. Brachial plexus injuries were divided according to ICD-9 codes into injuries to specific nerves: axillary nerve, median nerve, musculocutaneous nerve, radial nerve, ulnar nerve, cutaneous sensory nerve of the upper limb, cervical root injury, other specified nerve injury, multiple nerve injury and unspecified nerve injury.
1Texas
A&M Health Sciences Center College of Medicine; 2Division of Plastic Surgery, Department of Surgery, Baylor Scott and White Health, Temple, Texas USA Correspondence: Mr Edward Chamata, Texas A&M Health Sciences Center College of Medicine, 2401 South 31st Street, Temple, Texas 76508, USA. Telephone 832-818-3541, e-mail [email protected]
246
©2014 Canadian Society of Plastic Surgeons. All rights reserved
Plast Surg Vol 22 No 4 Winter 2014
Brachial plexus injuries with scapular fractures
Table 1 Prevalence of brachial plexus injuries in scapular fractures Scapular fracture location
ICD-9 code (open Scapular Brachial plexus and closed fracture) fractures, n injuries*, n (%)
Unspecified location
811.00 and 811.10
39,314
Acromial process
811.01 and 811.11
2908
62 (2.13)
Coracoid process
811.02 and 811.12
2166
48 (2.22)
6361
122 (1.92)
14,769
263 (1.78)
Glenoid cavity or neck 811.03 and 811.13 Body or spine Multiple fracture
811.04 and 811.14 811.99
Total
597 (1.52)
2600
81 (3.12)
68,118
1173 (1.72)
*(P
